Basic Information
| Provider Information | |||||||||
| NPI: | 1366947871 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KWONG | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 BRODERICK CT | ||||||||
| Address2: | |||||||||
| City: | CROFTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211141312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4436947079 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | MEDSTAR GEORGETOWN UNIVERSITY HOSPITAL | ||||||||
| Address2: | 3800 RESERVOIR ROAD | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024442000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2018 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.